What is the difference between an acute and a subacute TCA unit?
When a person is diagnosed with an eating disorder , they and their family face numerous challenges, including understanding how specialized care works and what treatment is needed at each stage of the disorder. Clinical and support service terminology can sometimes be confusing for those unfamiliar with it, but it's important to know what kind of care is provided in each type of treatment unit and what its objectives are.
You've probably heard professionals talk about "acute unit," "subacute" or "acute situations," but what do these terms mean and what do they imply in treatment?
When a person diagnosed with an eating disorder and under follow-up in a specialized circuit has an unfavorable evolution of the disorder, with loss of functionality and inability to maintain stability in community resources, admission to subacute hospitalization units that respond to a high-intensity, interdisciplinary therapeutic intervention may be suggested, but without high life risk, in which case admission to acute units would be indicated.
The treatment of eating disorders, an interdisciplinary work
In other words, acute hospitalization units handle cases with a high risk of life or behavior, while subacute hospitalization units handle cases that require further investigation into the causes of the disorder and have a moderate/high risk of complication.
What do we mean by an acute situation?
To understand an acute situation, we must talk about risk . We say that a person with an eating disorder is at high risk when they present two risk factors. These may occur simultaneously or separately, but either one is significant enough to warrant hospitalization in an acute care unit.
- Vital organ compromise : when the symptoms of an eating disorder, due to their persistence over time or their abrupt and intense onset, cause a collapse of the body's vital functions that puts the person's survival at risk. This includes severe malnutrition, kidney problems, cardiovascular issues, endocrine disorders, etc.
- Acute behavioral disturbance : when the psychological symptoms associated with the eating disorder lead the person to a situation of extreme distress and produce high-intensity self-harming or suicidal behaviors, suicidal acts and persistent agitation with risk of self-harm, injury to others or the environment.
When one of these two risk situations arises, acute hospitalization is indicated to manage the crisis. In this unit, patients receive intensive treatment, which lasts an average of 10 to 20 days, with the aim of reducing risk and restoring the minimum physical and psychological state necessary to resume their usual treatment.
What is the role of social work in cases of ED?
When, on the other hand, we talk about subacute hospitalization, we are referring to of a longer hospital stay, between 60 and 90 days. In this case, They set longer-term goals to work in depth on the social, family, and relational aspects that may be hindering recovery from the disorder. This specialized care is considered when a person affected by an eating disorder has presented an assessment indicating a risk of functional decline and exacerbation of their disorder with a moderate/high risk of complications. This admission assessment is carried out by a multidisciplinary team with professionals from the fields of psychiatry, specialized nursing, psychology, education, nutrition, and social work.
In this unit, the person and their family are monitored periodically, allowing for frequent assessments, with a time frame marked and limited by the achievement of objectives in an early rehabilitation plan that achieves the link to external, outpatient and specialized follow-up centers.
In what cases can subacute hospitalization be offered in eating disorders?
The following assumptions are indicative, understanding a certain flexibility in them, taking into account the specificity and individuality of each case and not giving them as rigid references and absolute criteria.
This healthcare resource is valued when:
- There is a diagnosis of eating disorder, at least one previous admission to an acute care unit, and despite following community treatment and having family support, the disorder continues to worsen without improvement in physical and psychological symptoms.
- There is a diagnosis of eating disorder, the patient is on their second or subsequent admission to an acute eating disorder unit, and a longer admission is suggested for better stabilization and coordination in referral to specialized community devices.
- There is a diagnosis of eating disorder, there is at least one previous admission to an acute care unit, and the treatments offered subsequently show a resistant response to it, suggesting a longer-term hospitalization that allows for better control and monitoring of the treatment with longer leave, but without losing the possibility of having a hospital bed in case of possible occasional crises, without reaching relapse.
The admission criteria would not be met when:
- There is no diagnosis of eating disorder, despite presenting compatible symptoms.
- There is a diagnosis of eating disorder and specialized outpatient follow-up without ever having required acute hospitalization for the disorder and no high risk of its symptoms.
- The patient presents with acute symptoms of an eating disorder with life-threatening risk, a BMI below 15, or severe, high-risk behavioral disturbances and suicidal intent, occurring more than three times per week. In these cases, the appropriate resource is an acute care hospital.
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